﻿<!DOCTYPE HTML>
<html>
	<head>
		<meta http-equiv="content-type" content="text/html; charset=utf-8" />
		<title>Liên Hệ</title>
	</head>
	<body>
		<table align="center"></tr><td width="600px">
		<form action="xuly.php" method="post">
			<fieldset>
				<legend><b>Enter Your Information</b></legend>
				<table>
					<tr>
						<td width="120px">
							Full name:
						</td>
						<td>
							<input type="text" name="txtName" size="40" />
						</td>
					</tr>
					<tr>
						<td>
							Address:
						</td>
						<td>
							<input type="text" name="txtAdd" size="40" />
						</td>
					</tr>
					<tr>
						<td>
							Phone:
						</td>
						<td>
							<input type="text" name="txtPhone" size="40" />
						</td>
					</tr>
					<tr>
						<td>
							Gender:
						</td>
						<td>
							<input type="radio" name="rdoGender" value="Nam" checked="checked" /> Male 
							<input type="radio" name="rdoGender" value="Nữ" /> Female
						</td>
					</tr>
					<tr>
						<td>
							Quốc gia:
						</td>
						<td>
							<select name="sltCountry">
								<option value="none">Select your country</option>
								<option value="Lào">Laos</option>
								<option value="Việt Nam">Vietnam</option>
								<option value="Nhật">Japan</option>
							</select>
						</td>
					</tr>
					<tr>
						<td>
							Study:
						</td>
						<td>
							<input type="checkbox" name="chkPHP" value="PHP & MySQL" /> PHP & MySQL 
							<input type="checkbox" name="chkASP" value="ASP.NET" /> ASP.NET
							<input type="checkbox" name="chkCCNA" value="CCNA" /> CCNA
							<input type="checkbox" name="chkSEC" value="Security" /> Security+
						</td>
					</tr>
					<tr>
						<td>
							Note:
						</td>
						<td>
							<textarea name="txtNote" cols="40" rows="5"></textarea>
						</td>
					</tr>
					<tr>
						<td>
						</td>
						<td>
							<input type="submit" name="btnSubmit" value="Send" /> <input type="reset" name="btnReset" value="Reset" />
						</td>
					</tr>
				</table>
			</fieldset>
		</form>
		</td></tr></table>
	</body>
</html>